Combined bi-occipital suboccipital transsinus transtentorial approach for resection of a pineal region falcotentorial meningioma: operative video and technical nuances

Neurosurg Focus. 2016 Jan:40 Video Suppl 1:2016.1.FocusVid.15452. doi: 10.3171/2016.1.FocusVid.15452.

Abstract

Large deep-seated meningiomas of the falcotentorial region present a formidable surgical challenge. In this operative video, the author demonstrates the combined bi-occipital suboccipital transsinus transtentorial approach for microsurgical resection of a large falcotentorial meningioma. This approach involves division of the less dominant transverse sinus after assessment of the venous pressure before and after clipping of the sinus with continuous neurophysiologic monitoring. Mild retraction of the occipital lobe and cerebellum results in a wide supra- and infratentorial exposure of extensive pineal region tumors. This video atlas demonstrates the operative technique and surgical nuances, including patient positioning, supra- and infratentorial craniotomy, transsinus transtentorial incision, and tumor removal with preservation of the vein of Galen complex. In summary, the combined bi-occipital suboccipital transsinus transtentorial approach provides a wide supra- and infratentorial surgical corridor for removal of select falcotentorial meningiomas. The video can be found here: https://youtu.be/3aD8h2uwBAo .

Keywords: bi-occipital suboccipital; combined supra- and infratentorial; falcotentorial meningioma; operative video; pineal region meningioma; technical nuances; transsinus transtentorial; video.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / surgery*
  • Craniotomy / methods
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Meningeal Neoplasms / diagnosis
  • Meningeal Neoplasms / surgery*
  • Meningioma / diagnosis
  • Meningioma / surgery*
  • Middle Aged
  • Pinealoma / diagnosis
  • Pinealoma / surgery*